Patients with acute respiratory failure requiring mechanical ventilation are at high risk for morbidity and mortality. Although several recent advances have improved management of such patients, these therapies have been incompletely adopted and patient outcomes continue to vary across hospitals. One factor that may be associated with improved translation of evidence into practice is the experience of the physician provider. Previous studies indirectly provide evidence for this relationship; for example, higher annual hospital volume is associated with reduced mortality. However, there is little direct evidence, physician experience has not been defined, and the capacity of organizational solutions to modify the relationship is unknown. A better understanding of this complex relationship could reveal novel targets for interventions to improve uptake of evidence-based practices of mechanically ventilated patients and ultimately their outcomes. Therefore the overall goal of this proposal is to understand the relationship between physician experience and outcomes for mechanically ventilated patients. Specifically, we will determine (1) if there is an association of physician experience, defined as years since completing of training, with patient outcomes; (2) the relative contributions of physician experience and hospital volume to patient outcomes; and (3) if effects of physician experience are modified by the presence of organizational factors. For this project we will create an innovative database linking multiple publicly available administrative and clinical datasets of patients hospitalized in the state of Pennsylvania with data obtained from a state-wide hospital survey and will use state-of-the-art statistical modeling techniques to advance our understanding of the role of the physician in patient outcomes. This database and career development award will be a foundation for the candidate's future work as an independent clinical researcher with a focus on developing and implementing organizational interventions to improve care of patients with acute respiratory failure. Dr. Meeta Prasad Kerlin has a clinical background in pulmonary and critical care medicine and a Master of Science in Clinical Epidemiology from the University of Pennsylvania. She has demonstrated her interest and aptitude for clinical research through the successful completion of several research projects in the topics of critical care outcomes and education. She has had multiple publications in high-impact journals such as JAMA and Critical Care Medicine. In this proposal, she has developed a career development plan that includes a complementary approach of didactic learning, structured professional development, intensive mentorship, and direct research experience leading the project described above. She has the full support of her department, outstanding mentors who are already the leaders in critical care outcomes research, and access to the vast resources of the University of Pennsylvania. Together, these will ensure her successful development into a leader in her own right.